Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-29T18:22:29.568Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence and recovery of post-surgical heart block in children following cardiac surgery

Published online by Cambridge University Press:  29 July 2022

Rohit Madani Open the ORCID record for Rohit Madani [Opens in a new window] ,
Elizabeth Aronoff ,
Jessica Posey ,
Mohua Basu ,
Tawanda Zinyandu ,
Paul Chai ,
Robert Whitehill ,
Kevin O. Maher  and
Asaad G. Beshish
Rohit Madani*
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Elizabeth Aronoff
Affiliation:
Emory University School of Medicine, Atlanta, GA, USA
Jessica Posey
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Mohua Basu
Affiliation:
Qualitative Analyst, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Tawanda Zinyandu
Affiliation:
Senior Research Coordinator, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Paul Chai
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Robert Whitehill
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Kevin O. Maher
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Asaad G. Beshish
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Author for correspondence: Rohit Madani, MD, Children’s Healthcare of Atlanta, Emory University School of Medicine, 2835 Brandywine Rd, Suite 400, Atlanta, GA 30341, USA. Tel: +1 – 248 – 840 – 2619. E-mail: rsmadani@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

A subset of patients who develop post-surgical heart block have recovery of atrioventricular node function. Factors predicting recovery are not understood. We investigated our centre’s incidence of post-surgical heart block and examine factors associated with recovery of atrioventricular node function.

Methods:

We conducted a single-centre retrospective study of patients 0 – 21 years who underwent cardiac surgery between January 2010 and December 2019 and experienced post-operative heart block. Data including patient and clinical characteristics and operative variables were collected and analysed.

Results:

Of 6333 surgical hospitalisations, 128 (2%) patients developed post-operative heart block. Of the 128 patients, 90 (70%) had return of atrioventricular node function, and 38 (30%) had pacemaker placement. Of the 38 patients who underwent pacemaker placement, 6 (15.8%) had recovery of atrioventricular node function noted on long-term follow-up. Median time from onset of heart block to late atrioventricular node recovery was 13 days (Interquartile range: 5 – 117). Patients with single-ventricle physiology (p = 0.04), greater weight (p = 0.03), and shorter cardiopulmonary bypass time (p = 0.015) were more likely to have recovery. The use of post-operative steroids was similar between all groups (p = 0.445). Infectious or wound complications were similar between pacemaker groups (p = 1).

Conclusions:

Two per cent of patients who underwent congenital cardiac surgery developed post-operative heart block, and 0.6% underwent pacemaker placement. Early recovery of atrioventricular node was associated with greater weight at the time of surgery, single-ventricle physiology, and shorter cardiopulmonary bypass time. Late recovery of atrioventricular node conduction following pacemaker placement occurred in 15.8% of patients.

Keywords

Congenital heart surgerypost-surgical heart blockpacemaker
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 7 , July 2023 , pp. 1150 - 1156
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Romer, AJ, Tabbutt, S, Etheridge, SP et al. Atrioventricular block after congenital heart surgery: Analysis from the Pediatric Cardiac Critical Care Consortium. J Thorac Cardiovasc Surg 2019; 157: 1168–1177 e1162.CrossRefGoogle ScholarPubMed
van Geldorp, IE, Vanagt, WY, Vugts, G et al. Late recovery of atrioventricular conduction after postsurgical chronic atrioventricular block is not exceptional. J Thorac Cardiovasc Surg 2013; 145: 1028–1032.CrossRefGoogle Scholar
Anderson, JB, Czosek, RJ, Knilans, TK, Meganathan, K, Heaton, P. Postoperative heart block in children with common forms of congenital heart disease: results from the KID Database. J Cardiovasc Electrophysiol 2012; 23: 1349–1354.CrossRefGoogle ScholarPubMed
Murray, LE, Smith, AH, Flack, EC, Crum, K, Owen, J, Kannankeril, PJ. Genotypic and phenotypic predictors of complete heart block and recovery of conduction after surgical repair of congenital heart disease. Heart Rhythm 2017; 14: 402–409.CrossRefGoogle ScholarPubMed
Liberman, L, Silver, ES, Chai, PJ, Anderson, BR. Incidence and characteristics of heart block after heart surgery in pediatric patients: A multicenter study. J Thorac Cardiovasc Surg 2016; 152: 197–202.CrossRefGoogle ScholarPubMed
Wilhelm, BJ, Thone, M, El-Scheich, T, Livert, D, Angelico, R, Osswald, B. Complications and Risk Assessment of 25 Years in Pediatric Pacing. Ann Thorac Surg 2015; 100: 147–153.CrossRefGoogle ScholarPubMed
Mah, DY, Prakash, A, Porras, D, Fynn-Thompson, F, DeWitt, ES, Banka, P. Coronary artery compression from epicardial leads: More common than we think. Heart Rhythm 2018; 15: 1439–1447.CrossRefGoogle ScholarPubMed
Silka, MJ, Shah, MJ, Silva, JNA et al. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: executive Summary. Heart Rhythm 2021; 18: 1925–1950.CrossRefGoogle ScholarPubMed
Weindling, SN, Saul, JP, Gamble, WJ, Mayer, JE, Wessel, D, Walsh, EP. Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 1998; 82: 525–527.10.1016/S0002-9149(98)00375-0CrossRefGoogle ScholarPubMed
Batra, AS, Wells, WJ, Hinoki, KW, Stanton, RA, Silka, MJ. Late recovery of atrioventricular conduction after pacemaker implantation for complete heart block associated with surgery for congenital heart disease. J Thorac Cardiovasc Surg 2003; 125: 1291–1293.CrossRefGoogle ScholarPubMed
Reid, JM, Coleman, EN, Doig, W. Reversion to sinus rhythm 11 years after surgically induced heart block. Br Heart J 1976; 38: 1217–1219.CrossRefGoogle ScholarPubMed
Bruckheimer, E, Berul, CI, Kopf, GS et al. Late recovery of surgically-induced atrioventricular block in patients with congenital heart disease. J Interv Card Electrophysiol 2002; 6: 191–195.CrossRefGoogle ScholarPubMed
Oster, ME, Chen, S, Dagincourt, N et al. Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network. J Thorac Cardiovasc Surg 2017; 153: 638–645 e632.10.1016/j.jtcvs.2016.10.078CrossRefGoogle ScholarPubMed